© Springer International Publishing AG 2017 195
A. Covic et al. (eds.), Resistant Hypertension in Chronic Kidney Disease,
DOI 10.1007/978-3-319-56827-0_13
Chapter 13
Obstructive Sleep Apnea and Resistant
Hypertension
Lauren A. Tobias and Francoise Roux
Introduction
Obstructive sleep apnea (OSA) is increasingly recognized as a modifiable contribu-
tor to systemic arterial hypertension. Patients with OSA have almost five times the
risk of having resistant hypertension [ 1 ], and studies of patients with resistant
hypertension demonstrate that a majority have OSA. Evidence suggests that treat-
ment with positive airway pressure (PAP) therapy results in significant blood pres-
sure reduction in these patients, supporting the need for accurate diagnosis and
prompt treatment.
OSA is a very common disorder, estimated to affect approximately 20% of men
and 10% of women, with increases seen in recent decades that likely relate to the
increasing prevalence of obesity [ 2 , 3 ]. OSA is characterized by repeated, intermit-
tent episodes of upper airway collapse during sleep that result in recurrent breathing
pauses. Pauses may cause either partial or complete obstruction of the upper airway
during sleep and are terminated either hypopneas or apneas, respectively. Clinical
consequences of OSA include loud snoring, transient oxygen desaturation, brain
arousals from sleep, and disruptions in sleep causing poor sleep quality [ 4 ].
Daytime consequences of these events include hypersomnolence, impaired con-
centration, an increased risk of motor vehicle accidents [ 5 , 6 ], and reductions in
quality of life.
L.A. Tobias
Assistant Professor, Section of Pulmonary, Critical Care and Sleep Medicine,
Yale University School of Medicine, New Haven, CT, USA
e-mail: [email protected]
F. Roux (*)
Pulmonary, Critical Care and Sleep Division, Starling Physicians, Hartford, CT, USA
e-mail: [email protected]